Pharmacy Practice, Unidad de Prácticas Tuteladas, Faculty of Pharmacy, University of Barcelone, Spain.
BMC Fam Pract. 2013 Jul 13;14:96. doi: 10.1186/1471-2296-14-96.
Drug dosing errors are common in renal-impaired patients. Appropriate dosing adjustment and drug selection is important to ensure patients' safety and to avoid adverse drug effects and poor outcomes. There are few studies on this issue in community pharmacies. The aims of this study were, firstly, to determine the prevalence of dosing inadequacy as a consequence of renal impairment in patients over 65 taking 3 or more drug products who were being attended in community pharmacies and, secondly, to evaluate the effectiveness of the community pharmacist's intervention in improving dosing inadequacy in these patients when compared with usual care.
The study was carried out in 40 Spanish community pharmacies. The study had two phases: the first, with an observational, multicentre, cross sectional design, served to determine the dosing inadequacy, the drug-related problems per patient and to obtain the control group. The second phase, with a controlled study with historical control group, was the intervention phase. When dosing adjustments were needed, the pharmacists made recommendations to the physicians. A comparison was made between the control and the intervention group regarding the prevalence of drug dosing inadequacy and the mean number of drug-related problems per patient.
The mean of the prevalence of drug dosing inadequacy was 17.5% [95% CI 14.6-21.5] in phase 1 and 15.5% [95% CI 14.5-16.6] in phase 2. The mean number of drug-related problems per patient was 0.7 [95% CI 0.5-0.8] in phase 1 and 0.50 [95% CI 0.4-0.6] in phase 2. The difference in the prevalence of dosing inadequacy between the control and intervention group before the pharmacists' intervention was 0.73% [95% CI (-6.0) - 7.5] and after the pharmacists' intervention it was 13.5% [95% CI 8.0 - 19.5] (p < 0.001) while the difference in the mean of drug-related problems per patient before the pharmacists' intervention was 0.05 [95% CI( -0.2) - 0.3] and following the intervention it was 0.5 [95% CI 0.3 - 0.7] (p < 0.001).
A drug dosing adjustment service for elderly patients with renal impairment in community pharmacies can increase the proportion of adequate drug dosing, and improve the drug-related problems per patient. Collaborative practice with physicians can improve these results.
在肾功能受损的患者中，药物剂量错误很常见。为了确保患者的安全，避免药物不良反应和不良结局，进行适当的剂量调整和药物选择非常重要。社区药房在这方面的研究很少。本研究的目的首先是确定在接受社区药房治疗的 65 岁以上服用 3 种或更多药物的患者中，由于肾功能受损导致剂量不足的发生率，其次是评估社区药师干预对改善这些患者的剂量不足与常规护理相比的有效性。
该研究在西班牙 40 家社区药房进行。该研究分为两个阶段：第一阶段为观察性、多中心、横断面设计，用于确定剂量不足、每位患者的药物相关问题，并获得对照组。第二阶段为具有历史对照组的对照研究，为干预阶段。当需要调整剂量时，药剂师向医生提出建议。比较对照组和干预组之间药物剂量不足的发生率和每位患者的平均药物相关问题数。
第一阶段药物剂量不足的发生率为 17.5%[95%置信区间 14.6-21.5]，第二阶段为 15.5%[95%置信区间 14.5-16.6]。第一阶段每位患者的平均药物相关问题数为 0.7[95%置信区间 0.5-0.8]，第二阶段为 0.50[95%置信区间 0.4-0.6]。在药剂师干预之前，对照组和干预组之间药物剂量不足的发生率差异为 0.73%[95%置信区间（-6.0）-7.5]，干预后为 13.5%[95%置信区间 8.0-19.5]（p<0.001），而在药剂师干预之前每位患者的平均药物相关问题数差异为 0.05[95%置信区间（-0.2）-0.3]，干预后为 0.5[95%置信区间 0.3-0.7]（p<0.001）。
社区药房为肾功能受损的老年患者提供药物剂量调整服务，可以提高适当药物剂量的比例，并改善每位患者的药物相关问题。与医生合作实践可以改善这些结果。
